| Part one: Type 2 diabetes mellitus, hyperhomocysteinemia and 10-year risk of cardiovascular events: general population by epidemiological cross-sectional survey based, cross-sectional studyObjective Hyperhomocysteinemia(Hhcy) can be observed in many diseases, such as cardiovascular diseases, nervous system disorders. Previous studies had showed that in the general population or with Chronic Kidney Disease(CKD) subjects Hhcy could increase the risk of cardiovascular events. However, a clear relationship between Hhcy level and type 2 diabetes(T2DM) has not been established. We aim to research the prevalence of Hhcy in T2 DM patients and to evaluate the relationship between T2 DM, Hhcy and the 10-year risk of cardiovascular events.Method This cross-sectional study, which was carried out in Shaanxi province, China, was part of the 2007-2008 China National Diabetes and Metabolic Disorders Survey. Inclusion criteria: 1. the age was 20 years or older; 2. The subjects should have lived in Shaanxi province for at least 5 years. Individuals who presented with thyroid disease or cancer or for whom Hcy information was lacking were excluded; Individuals who presented with renal insufficiency and those who had a history of coronary or cerebrovascular disease were also excluded; Individuals with taking into metformin or pregnant were excluded. A standard questionnaire was used to collect demographic information and we collected blood sample for laboratory test. Every individual was also given physical examination. Oral glucose tolerance test was used to diabetes and we use Framingham risk score to assess 10-year risk cardiovascular events.Result A total of 2,303(male 946, female 1357) individual were included in this study and the prevalence of Hhcy in the population with T2 DM was comparable to that in the population without T2DM(71.0 % vs. 68.1%,P=0.55). Logistic regression analyses showed that T2 DM was not significantly associated with Hhcy prevalence in the total population(OR: 0.80, 95% CI: 0.55–1.17, P=0.25). The results showed that the FRS was 20.40% in the population with T2 DM only, 6.99% in those with Hhcy only, and 23.33% in those with T2 DM and Hhcy, which were all significant higher than the FRS in healthy controls(4.10%). However, no significant difference in FRS was observed between the population with both T2 DM and Hhcy and the population with T2 DM only(P = 0.091).Conclusion The present study identified that no difference in the prevalence of Hhcy between the participants with and without T2 DM. In addition, our results suggested that Hhcy did not increase the 10-year risk of cardiovascular events in patients with T2 DM. Therefore, also considering the fact that lowering Hcy levels does not significantly decrease vascular risks as shown in previous studies and high prevalence of Hhcy, we do not recommend routine screening for Hcy levels in the Chinese population with T2 DM.Part two: The relationship between folate and type 2 diabetesObjective Folate is a water-soluble B vitamin, which has some connection with a variety of diseases, including endocrine diseases(T2DM, gestational diabetes, and so on). The research about relationship between folate and T2 DM was still disputed. We found the objects, diagnosed T2 DM for many years, took metformin in many literatures. As metformin can affect the metabolism of folate, it is meaningful to reassess the relationship between folate and T2 DM. We aim to compare the plasma folate levels in general population and T2 DM patients, and assess the relationship between folate and other factors.Method This cross-sectional study, which was carried out in Shaanxi province, China, was part of the 2007-2008 China National Diabetes and Metabolic Disorders Survey. Inclusion criteria: 1. the age was 20 years or older; 2. the subjects should have lived in Shaanxi province for at least 5 years. Individuals who presented with thyroid disease or cancer or for whom folate information was lacking were excluded; Individuals who presented with renal insufficiency and those who had a history of coronary or cerebrovascular disease were also excluded; Individuals with taking into metformin or pregnant were excluded. A standard questionnaire was used to collect demographic information and we collect blood sample for laboratory test. Every individual was also given physical examination. Oral glucose tolerance test was used to diabetes and we use bioelectrical impedance analysis to assess body fat percentage.Result A total of 2,303(male 946, female 1357) individual were included in this study. The plasma folate level was significantly higher in T2 DM patients(8.04 nmol/L) than that in general population(6.95nmol/L). In addition, with the increasing of plasma folate level, blood glucose, insulin level and the prevalence of T2 DM also raised(all P<0.05). Linear regression analysis showed that T2 DM was significantly correlated with plasma folate level, no matter being corrected(P=0.002) or not(P=0.004).Body fat percentage and smoking also significantly correlated with plasma folate level(all P<0.05).Conclusion The present study identified that the plasm a folate level was significantly higher in T2 DM patients than that in general population, and with the increasing of plasma folate level, blood glucose, insulin level and the prevalence of T2 DM also raised. Linear regression analysis showed that T2 DM and body fat percentage significantly correlated with plasma folate level. Above all, we do not recommend T2 DM patients without taking metformin supply folate. |
PDF Full Text Request